ACUTE KIDNEY INJURY (ACUTE RENAL FAILURE) IN PREGNANCY

Many complications associated with pregnancy may induce AKI (acute kidney injury or acute renal failure).

ACUTE KIDNEY INJURY (ACUTE RENAL FAILURE) IN PREGNANCY

 

Many complications associated with pregnancy may induce AKI (acute kidney injury or acute renal failure). In the early period of pregnancy, pre-renal disease (fluid loss and dehydration) or acute tubular necrosis may follow hyperemesis gravidarum (persistent vomiting) or septic abortion. In the late pregnancy period, acute renal failure may induced by preeclampsia, thrombotic microangiopathies, acute fatty liver of pregnancy, renal cortical necrosis, pyelonephritis, urinary tract occlusion or kidney stone disease.   

The finding of low platelet count (thrombocytopenia) and anemia (low hemoglobin) with acute kidney injury may be induced by either thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) or severe preeclampsia with the HELLP syndrome. A full detailed history with a complete battery of investigation will help differentiation these disorders. Therapy of preeclampsia associated with HELLP syndrome can be induced by delivery institution.

Preeclampsia 

Severely presented preeclampsia is much more prevalent than TTP-HUS and is usually clinically preceded by features of hypertension and proteinuria and may be edema of lower limbs that could be intense. Kidney failure is uncommon even in severe cases, unless there’s intense bleeding with hemodynamic deterioration or intense disseminated intravascular coagulation (DIC). However, a mild degree of azotemia (elevated renal profile) may occur, due in part to permeability decline in the glomerular capillary wall.

With severe preeclampsia urgent delivery is mandatory. The renal and extrarenal alterations typically start to resolve spontaneously within 2-3 days after delivery and virtually almost complete recovery of kidney function ensues within two months after delivery, although microalbuminuria (microalbumin in urine) may still observed.

Management of TTP-HUS is similar to that in the non-pregnant women. Induction of deliver is crucial for TWO reasons, first to abort fetal sequelae of placental microthrombi, second, difficulty in distinction from preeclampsia. Acute fatty liver is a rarely observed complication of pregnancy with multiple clinical and laboratory associations commonly seen with preeclampsia and may induce acute renal failure, hypoglycemia, hypofibrinogenemia, liver enzymes alterations, and an increased PTT. Treatment approach may include management of DIC with labor should be induced immediately.

 

Bilateral cortical necrosis may complicate severe hypotension (low blood pressure) and/or disseminated intravascular coagulopathy that seen with abruptio placentae, symptomatic placenta previa, neglected intrauterine fetal death, or amniotic fluid embolus. Clinical features may include: oliguria (little urine) or anuria (no urine), gross hematuria (blood in urine seen by naked eyes), loin pain, and low blood pressure. Diagnosis can be established by either ultrasound or by CT scanning. There is no dedicated therapy for this disorder, many cases will be dialyzed despite some cases may show incomplete kidney function recovery.

Acute pyelonephritis (kidney infection) may cause acute renal failure among pregnant females even with absence of septicemic state or hypotension. Partial kidney recovery after culture and sensitivity and proper antibiotic therapy may be seen due to irreversible kidney damage.  

Although mild dilatation of the collecting systems attributable to the hormonal and anatomical alterations in pregnancy is usually not associated with renal dysfunction among pregnant patients, occasionally obstruction is sufficient to cause renal failure.  Diagnosis can be accomplished by an observed normalization of kidney function in the lateral recumbent posture and the recurrent dysfunction with supine position. Insertion of a ureteral catheter or fetal delivery may be mandatory. Obstruction of the urinary tract can be induced by kidney stones with acute loin pain and frank hematuria rather than kidney failure. This disorder can be established easily by kidney ultrasound studies.

N.B. This Blogger is created to declare the potential dangers, the kidney of a pregnant lady might be exposed.